Gallbladder Anatomy and Surgical Nursing

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Questions and Answers

Which structure is essential for the exocrine function of the pancreas?

Islets of Langerhans

Duct of Wirsung (correct)

Celiac axis

Common bile duct

What is the anatomical structure primarily affected in 95% of pancreatic tumors?

Stomach

Tail of pancreas

Head of pancreas (correct)

Body of pancreas

What is the main purpose of a pylorus preserving pancreaticoduodenectomy?

To remove the entire stomach

To prevent pancreatic enzyme secretion

To preserve the pyloric sphincter and maintain gastrointestinal continuity (correct)

To improve blood supply to the pancreas

Which of the following is NOT a component removed during a laparoscopic Whipple resection?

Pyloric sphincter Signup and view all the answers

Which pancreatic cancer's symptom is likely due to bile duct obstruction?

Jaundice Signup and view all the answers

What is the primary function of the liver related to blood glucose levels?

Regulation of blood glucose levels through glycogen storage Signup and view all the answers

Which ligaments are involved in a splenectomy?

Falciform ligament Signup and view all the answers

Which vessels are involved in the hepatic blood supply?

Aorta and hepatic artery Signup and view all the answers

What is the purpose of hepatic resection?

To remove tumors from the liver Signup and view all the answers

What is contained within the portal triad of each liver lobe?

Hepatic ducts, branch of hepatic portal vein, and branch of hepatic artery Signup and view all the answers

What is the average storage capacity of the gallbladder?

40 to 70 mL Signup and view all the answers

Which artery supplies blood to the gallbladder?

Cystic artery Signup and view all the answers

What is the main purpose of the Endoscopic Retrograde Cholangeopancreatography (ERCP) procedure?

Diagnose problems in the biliary tract Signup and view all the answers

What type of procedure is a choledocholithotomy?

Incision of the common bile duct Signup and view all the answers

Which surgical intervention is most commonly performed laparoscopically?

Cholecystectomy Signup and view all the answers

During an ERCP, where is the scope inserted?

Mouth Signup and view all the answers

What indicates the presence of gallstones during a cholangiogram?

Highlighted stones in the biliary tree Signup and view all the answers

What role does the scrub nurse have during blood loss preventative measures?

Count surgical instruments Signup and view all the answers

What is the main function of the spleen?

Filter blood cells, produce white blood cells, and store blood Signup and view all the answers

Which type of pancreatic transplant is most common?

Simultaneous Pancreas-Kidney Transplant (SPK) Signup and view all the answers

What are the critical steps in performing a splenectomy?

Clamping and tying the splenic artery, then removing the spleen Signup and view all the answers

Which equipment is specific to the laparoscopic approach during a splenectomy?

GIA type stapler for ligaments Signup and view all the answers

After a successful pancreas transplant, what happens to insulin-dependent patients?

They eliminate the need for glucose monitoring Signup and view all the answers

What types of patients are typically candidates for a pancreas transplant?

Patients with type 1 diabetes without cancer Signup and view all the answers

What is a major consideration during a splenectomy procedure?

Blood replacement and hemostatic agents Signup and view all the answers

What must be ligated in the splenic blood supply during a splenectomy?

Both the splenic artery and splenic vein Signup and view all the answers

What is the primary purpose of using the CUSA in liver transplant procedures?

For hemostasis during dissection Signup and view all the answers

Which of the following best describes the types of donors for liver transplants?

Cadaveric and Living Related Signup and view all the answers

What is the primary solution used to preserve donor livers for transplantation?

University of Wisconsin Solution Signup and view all the answers

Which type of anastomosis involves connecting the portal veins during liver transplantation?

Portal Vein to Portal Vein Signup and view all the answers

What is the main function of the Forced-Air warming blanket during a transplant surgery?

To maintain the patient's body temperature Signup and view all the answers

What type of sutures are recommended for permanent vascular anastomosis during liver transplantation?

Prolene Suture Signup and view all the answers

What is essential to maintain during the organ donation process?

Aseptic Technique Signup and view all the answers

What is the primary use for the Argon Laser in surgery?

For tissue cutting and hemostasis Signup and view all the answers

Study Notes

Gallbladder Anatomy and Function

Located behind the liver, the gallbladder stores and concentrates bile, with an average capacity of 40 to 70 mL.
Bile aids in digestion and is released into the duodenum.
Supplied by the cystic artery, a branch of the hepatic artery.

Perioperative Nursing Considerations

Use of general anesthesia for cholecystectomy, performed either open or laparoscopically.
Patients are positioned supine, with measures in place for blood loss prevention, including the scrub nurse's role.

Surgical Counts

Initial and closing counts for open cholecystectomy are major; final count is minor.
Laparoscopic procedures have a major initial count and minor closing and final counts.

Surgical Interventions

Common procedures:
- Gallbladder: Cholecystectomy, ERCP (Endoscopic Retrograde Cholangiopancreatography).
- Spleen: Splenectomy.
- Liver: Hepatic resection, liver transplant.
- Pancreas: Whipple procedure, pancreatic transplant.

ERCP Procedure

ERCP is a diagnostic procedure for the biliary tract involving scope insertion from the mouth to the duodenum.
X-ray-guided with a catheter to visualize the common bile duct and identify blockages.

Cholangiogram

Conducted intraoperatively; involves injecting contrast dye into the cystic duct to highlight blockages.
Choledocholithotomy is performed to remove stones from the common bile duct.

Cholecystectomy

Indicated for chronic inflammation and cholelithiasis; 90% are performed laparoscopically.
Key steps include incising the Triangle of Calot, ligating and dividing the cystic artery, and dissection of the gallbladder from the liver bed.

Pancreas Anatomy

Head of the pancreas sits against the duodenum; receives its blood supply from the celiac axis and SMA.
The pancreas has exocrine functions (secreting enzymes) and endocrine functions (insulin and glucagon secretion).

Pancreatic Cancer

95% of tumors arise from the head of the pancreas; 80% are ductal adenocarcinoma.
Symptoms include jaundice due to bile duct obstruction, and the disease has a late diagnosis and poor prognosis.

Laparoscopic Whipple Resection

Involves the removal of head of pancreas, entire duodenum, part of jejunum, distal stomach, and lower half of the common bile duct.
Aim to reestablish continuity post-tumor removal for better quality of life.

Anastomoses in Whipple Procedure

Involves three major connections: pancreaticojejunostomy, hepaticojejunostomy, and gastrojejunostomy.

Pancreatic Transplant

Options include pancreas transplant alone (PTA), simultaneous pancreas-kidney transplant (SPK), or pancreas after kidney transplant (PAK).
Aimed at preventing complications of Type 1 Diabetes, with lifelong immunosuppressants required.

Spleen Anatomy and Function

Located in the upper left quadrant, protected by ribs; responsible for filtering blood cells and producing white blood cells.
Blood supply from the splenic artery, draining into the portal system; both supplies must be ligated in a splenectomy.

Splenectomy Indications

Performed due to trauma, malignant conditions, hemolytic jaundice, and splenomegaly.

Liver Anatomy and Function

Located in the right upper quadrant; metabolizes nutrients and regulates blood glucose levels.
Composed of lobules divided by the falciform ligament containing a portal triad.

Liver Blood Supply

Receives arterial blood from aorta and hepatic artery, while venous blood comes from IVC and portal vein.

Hepatic Resection

Conducted for tumor removal; involves achieving hemostasis and careful monitoring intraoperatively.

Liver Transplantation

Involves donor liver implantation with cadaveric or living-related donors.
Requires complex anastomosis of hepatic arteries and veins, along with biliary reconstruction.

Organ Donation

Managed by the Trillium Gift of Life Network in Ontario.
Types of donors include neurological determination of death (NDD) and after circulatory death (DCD).

Maintenance of Aseptic Technique

Critical during organ donation procedures to ensure safety and prevent infection.

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Description

Explore the anatomy and function of the gallbladder, along with perioperative nursing considerations for cholecystectomy. This quiz covers important surgical interventions and the role of surgical counts in both open and laparoscopic procedures. Test your understanding of these critical concepts in surgical nursing.